Intactivism News

September 2012

Uganda: Tororo Women Discourage Men From Circumcision

By Faustin Odeke

Tororo women are discouraging their husbands from undergoing circumcision, health authorities have disclosed.

Willy Mungoma, the district health educator, said ... "In our routine sensitisation programmes and radio tallkshows, women challenge us to explain how long their husbands would take to heal. This is because they think taking a long time to heal would make them miss sex,"...

...

Under the National Priority Action Plan, the health ministry targets having 1,250,000 men circumcised by 2013. They also want 3.5 million men counseled and tested for HIV/AIDS.

...

The district chairman, Emmanuel Osuna, said some of the circumcised men were being promiscuous, a trend that increases the number of new infections since circumcision provides only about 60% protection.

He appealed to leaders in the district to sensitise and mobilise men for HIV testing and circumcision.

Study: Castration Adds Years to Men's Lives

By Lindsay Abrams

PROBLEM: It's suspected that there is a biological trade-off between reproduction and longevity, the theory being that our mechanisms of repairing damaged genetic material are limited and thus relegated to the most evolutionarily advantageous repair work. Propagating our genes, it would follow, trumps living to see/attempting to control the lives of proceeding generations. The male sex hormone is implicated in this theory, and taking into account that fact that women tend to live significantly longer than men, may be responsible for limiting men's lifespan.

METHODOLOGY: Because sometimes you can't offer enough cash or college credit to put together a randomized control experiment, researchers did a (very) retrospective study of Korean eunuchs from the Chosun dynasty, which stretched from the late 14th to the early 20th century. The eunuchs, a class of nobles employed as guards at the royal palace, preserved their lineage through the adoption of castrated sons and kept detailed genealogical records, which the researchers cross-verified with other historical accounts.

RESULTS: Averaging a lifespan of 70 years, the eunuchs lived about 14 to 19 years longer than cohorts from a similar socio-economic background. The group of 81 eunuchs included three centenarians among their ranks -- making them 130 times more likely to celebrate their 100th birthday than, for example, men in the present-day U.S.

CONCLUSION: The seniority achieved by the eunuchs supports the theory that the male sex hormones decrease men's lifespan.

IMPLICATIONS: Another study that used data from a population in a mental hospital also indicates that castrated men live longer, although a third looking at castrati singers did not show an increase in lifespan along with their expanded vocal range. While these new findings may not be enough to make anyone seriously consider asking whether added years at the expense of one's genitals are worth living, they may lead to further understanding of the relationship between reproduction and aging.

Islamic Sydney Doctor, Wife Deny Genital Mutilation of Daughters

By Vittorio Hernandez

A doctor and his pharmacist-wife from Sydney, New South Wales, denied participating in the genital mutilation of their two daughters. The couple, who belong to a small Islamic sect, appeared on Wednesday at the Parramatta Local Court to face two charges of female circumcision.

Court records said that the first procedure was in metropolitan Sydney and the second in the NSW south coast which took place the past two years when the girls were only six- and seven-years-old then.

The couple, ages 42 and 35, has several co-accused including a 58-year-old sheikh who was charged with being an accessory to the genital mutilation. Court records said the sheikh told locals in the past months to lie to investigators about the practice of female circumcision in their community.

John Sutton, the solicitor of the couple, told the court that the accused belong to a very small religious community but the charges are not linked with their Islamic faith since it was not part of a religious act or rite.

The procedure was allegedly performed by a 68-year-old retired nurse who is charged with mutilation and is scheduled to appear on Oct 3 at the Campbelltown Local Court. Besides the retired nurse, four other women from Sydney and Wollongong are included in the charges since they were present during the procedure.

The Medical Council of NSW also plans to raise the matter of the doctor's involvement in the procedure with the Health Care Complaints Commission with the possibility of imposing disciplinary action on the father of the two girls. The Pharmacy Council of NSW is also studying the possibility of suspending the professional registration of the girls' mother.

The parents denied the charges but refused to say anything further. Together with the sheikh, they will appear again before the same Parramatta court on Nov 8.

U.S center for disease control revises circumcision strategy

Harare(ZimEye)-The US U.S. Center for Disease Control and Prevention in Zimbabwe says they are going back to the drawing board and map ways of convincing Zimbabwean males to get circumcised.

The development comes after only 75 000 people have been circumcised since the initiation of the program in 2009 as a measure of eradicating HIV.

The programme intends to circumcise 1.2 million by the year 2015.

Health experts say circumcision reduces HIV contraction by 60% but insist that it is not an effective way of preventing the pandemic. [There's many a true word....]

“There is some research going on on the second generation of understanding what motivates people, what their barriers are in accessing circumcision services and we will use that to address their concerns,” U.S. Centers for Disease Control and Prevention Country Director Peter Kilmarx, told Zimeye on the sidelines of the ongoing HIV/AIDS prevention monitoring & evaluation techniques workshop in Harare.

[Kilmarx and the CDC assume they know what is best for Zimbabwean men, better than the men themselves - though the men know better, first-hand, what it is like to be intact and what they would lose by getting circumcised.]

...

AIDS levy which is the only domestic source of the country’s AIDS programs is also in doubt owing to controversies surrounding its management by the National AIDS Council which administer the fund.

The German Justice Ministry has released further details of its proposed law to enable unnecessary circumcision of non-consenting minor boys. They abandon the idea of an exemption for religious circumcision, but bring it under the rubric of "medical" circumcision. This is in spite of the fact that the change is being made specifically to allow religious circumcision. (There is virtually no demand in Germany for "cultural" circumcision like that in the USA.)

Circumcision of boys - Key Elements of a Regulation

I. Text of the Proposed Rules:

"Circumcision of the male child

(1) The child's care includes the right to consent to a medically not-indicated circumcision of a child who is not old enough to comprehend or consent, if these are carried out according to the rules of medical science. This does not apply if the child's welfare in endangered by circumcision, taking into account its purpose.

(2) In the first six months after birth, circumcision of a male child may be also carried out by individuals designated by religious groups, without being physicians, if they are specially trained."

II. Background

With the (legally binding) judgment of 7 May 2012 (document number: 151 Ns169/11, NJW 2012, 2128), the Regional Court of Cologne concluded that the circumcision of a 4-year-old boy was an illegal assault within the meaning of § 223 paragraph 1 of the Criminal Code (CC), even if undertaken in accordance with the rules of the medical profession and performed with the approval of the Muslim parents for religious reasons.

Parental consent was irrelevant because circumcision is contrary to the requirements of child custody to serve the child's best interests.

To address the resulting legal uncertainty, the German Bundestag requested the following of the federal government by order of 19 July 2012 (Bundestag printed paper 17/10331) [There was no "legal uncertainty" - non consented infant circumcision breaks the Basic Law - there is only a religious demand and political pressure.] :

"Taking into account the constitutionally protected parts of child welfare, physical integrity, freedom of religion and the right of parents to educate[but not to modify] as they see fit, submit [to us] a bill that ensures that a medically professional male circumcision without undue pain is generally admissible."

[Nowhere do they address the breach of gender-equality implicit in this. How will they resist, when Muslim parents demand the right to have doctors "circumcise" their daughters - minimally, surgicaly - under the same law?]

III. Key points of the proposed rule:

Custodial approach: The discussion centered on the question of the reach of parental authority. A regulation therefore should be enshrined and made clear with the Children's Law (§ 1631d BGB) that the parents (with custody under Article 6 Section GG 2, § § 1626, 1631 BGB) may consent to the circumcision of their son under certain conditions.

Parental consent shall preclude any claims of illegality of the procedure with the consequence that properly performed circumcision of boys cannot be punished as assault and no liability for damages shall trigger. [This seems to forclose the man's later right to sue for the wrong that has been done to him.]

Confinement of the proposed regulation to circumcision of boys unable to give consent: Only actually problematic circumcisions of boys unable to give consent would be governed by the judgment of the Court of Cologne.

Religious or ritual-traditional circumcisions are regularly performed at an age where children lack insight and judgment and therefore cannot render effective consent to the procedure. [An excellent reason not to do it to them without consent.] In Judaism, this means on the eighth day after birth. In Islam depending on the sect and culture it could mean anywhere from the seventh day after birth to about the end of primary school age.

Medically indicated circumcisions are excluded: Medically necessary (= Medically indicated) circumcisions are not the subject here, as there is common ground that parents have the authority to consent to medically indicated circumcision of children too young to comprehend and consent, as with any other medically necessary treatment of their child. [Thus any claims of medical benefit are irrelevant.]

No special religious requirement: The law shall be deliberately designed such that the requested circumcision is not dependent on a religious motivation to be legal. Otherwise legal practice would face before all else the difficult task of having to determine the content and specifics of religious beliefs. [Yet this is the sole reason for the "necessity" of a change to the law.]

Apart from religious bases, parents can appropriately elect the globally-now-common [No, only in the United State] , even though not medically indicated, circumcision of their son for an assortment of reasons having to do with beliefs about the welfare of their child. (See, for example, the opinion of the American Academy of Pediatrics from August 2012 that states the health benefits of newborns circumcision outweigh the risks. Pediatrics 2012, 130: 585-586 [Annotated here, video rebuttal here] ).

A scheme recognizing solely religiously-motivated circumcision of boys would not encompass all the varying valid reasons for choosing circumcision and would therefore not be fair or legally enforceable.

Conditions in the interests of the child: The consent of the parents must be bound up with child welfare-oriented conditions for the circumcision, which are increasingly being mentioned in the public debate on this issue (see Ethics, press release of 23 August 2012).

Parents should be able to provide consent for circumcision that is not medically indicated, on their son who cannot give consent, under the following conditions:

• Circumcision must be carried out according to the guidelines of medical science: This includes a professional execution of the procedure, hygienic conditions - as this is also covered by the rules of medical science - and the provision of effective pain management appropriate to individual cases and with respect to medical standards.

• Duty of circumcisers to fully educate parents before the procedure: A comprehensive explanation to parents of the consequences and risks is already a prerequisite for their effective consent under applicable law.

Properly warranted consent to a medically non-indicated intervention into someone's physical integrity is mandatory under current law. It requires an appropriate and more comprehensive explanation to the legal interest holder or - as here - his legal representatives. An additional mention of this requirement in the text of the proposed regulation is therefore not necessary.

• About the caveat of attention to the welfare of the child in paragraph 1, sentence 2, the constitutional protection mandate may be taken into account, if the circumstances of the individual case result in a hazard to the child. In this context any contrary will of the child may ["may"? Why not "must"?] also be take into account.

In Germany, the circumcision of children - even those carried out on religious or traditional grounds - is performed by physicians in a great many cases. However, religiously motivated circumcisions may also be performed by persons designated by a religious society.

The proposed plan allows such designated persons to carry out circumcisions when they have been specifically trained and exhibit circumcision qualifications comparable to those of a surgeon. The conditions and requirements set out in Paragraph 1 above also shall apply to circumcisions by such persons.

The proposed regulation should limit the assessment of religious freedom on the one hand and the health interests of the child on the other hand to strictly the first six months after the child's birth. [Do children magically gain constitutional rights six months after they are born - or are they just easier to hold down? Is this all just about Germans being squeamish about forcibly circumicising boys old enough to complain?]

The organisation’s director, Walter Obiero said the action has been taken due to cut in funding. He, however, declined to state annual funding to the body since its inception three years ago. But employees The Standard spoke to gave the figure of Sh595 million [$US7,021,000].

Technical support

The report dated August 21, 2012, of which The Standard has a copy, details massive financial impropriety. The assessment was done by the Centre for Disease Control (CDC) in Atlanta, US. They are Procurement and Grant Office (PGO), and Programme Budget and Extramural Management Branch. CDC offers technical support to NRHS, which is based in Kisumu, with operations spread across the country.

CDC has categoriosed NRHS as a ‘high-risk’ organisation, which means that other donors should be wary of it. “NRHS is required to work with CDC Kenya on revising their application to conform to the decreased scope of activities,” reads part of the report.

Among the impropriety is that NRHS went outside its approved CDC budget, and purchased 25 vehicles without CDC or NRHS Board of Directors consent.

“The organisation can spend Sh1 million [$US11,800] on imprest, in less than two weeks. Our assessment found gross mismanagement of the funds. HRHS does not have a limit on the amount of petty cash,” states part of the report that is signed by Shirley Wynn of PGO.

Furthermore, the report reveals contract salaries for workers differ from those they are paid. For instance, an employee’s salary is Sh35,280 [$US416.30], but the contract amount is Sh25,000 [$US295] although the report finding states that the difference can be accounted for.

Humanists put circumcision ethics on UN agenda

The International Humanist and Ethical Union has presented papers to the United Nations Human Righs Council naming non-therapeutic circumcision as a human rights issue that requires the council's attention.

At the session of September 17, IHEU representative Josephine Mackintosh
told the Council:

The recent German [Cologne district] court ruling outlawing non-therapeutic infant male circumcision correctly places the welfare, and the "fundamental rights and freedoms" of vulnerable children above the unrestrained expression of adult beliefs.

The court correctly determined that: non-therapeutic cutting of a child's body is an assault; that children are unable to give informed consent; that surrogate parental consent is not valid for an operation with no clinical indication and with the potential to cause serious harm; and that children have a right to be protected from bodily harm.

Such determinations cannot legitimately be overridden by adults convinced that children might be harmed by denying them this forced, irreversible surgery to their most intimate body parts. When the children become adult they can freely decide whether or not to undergo the procedure.

We understand, and have some sympathy with the sensitivities of certain religious groups which may feel threatened or even attacked by the judgment, particularly in the light of recent history. But it would be wrong to describe this judgment as religious persecution, or anti-Semitic; some Jewish voices are calling for an end to the practice and there is even an association called Jews Against Circumcision. Powerful groups must not be permitted to impose their views on the vulnerable on ideological or theological grounds in contravention of international law.

The Royal Dutch Medical Association and seven other Dutch scientific associations concluded in 2010 that the procedure can be harmful and that it violates the boy's human rights to autonomy and physical integrity.

The German judgment is therefore both laudable and overdue. Reflecting as it does States' obligations under the ICCPR, it should be followed by all member states.

This article is part of an ongoing series from the American Association of Clinical Urologists (AACU), based on a partnership between the AACU and Urology Times. Articles are designed to provide updates on legislative processes and issues affecting urologists. ...

Male circumcision has recently been the focus of intense debate by policy makers and religious leaders. The sensitivity of this issue mandates a serious and unbiased review of legislative and religious activities across the U.S. and elsewhere to determine its impact on the practice of urology.

Legislators, researchers, imams, and rabbis argue whether male circumcision decreases certain diseases, whether a child can or should give consent, or whether religious freedom should trump all of this. Public policy discussions that are taking place throughout the Western world—specifically, the U.S.—have implications for urologists.

Americans are mostly insulated from horror stories around the globe, such as in Indonesia, where religious extremists who practice forced circumcision on men, children, and even pregnant women in attempts at forced religious conversion; or in South Africa, where certain cultures allow for the forced circumcision of boys deemed to be “past the age of initiation.” Female circumcision is now called “female genital mutilation” and is illegal in most of the Western world.

In the U.S., legal disputes about circumcision are settled in the courts. Most often, these cases involve parents who have differing opinions about having the procedure performed on their child, hospitals that mistakenly circumcise infants, or liability suits when a procedure leads to complications.

A few relatively recent events could have the potential to ignite the debate between those who hold that circumcision is part of religious freedom and those who say it’s a violation of a child’s right to bodily integrity, thereby placing doctors in the spotlight.

Rabbis in New York have stated that they will defy that city’s ban on a ritual form of circumcision ... the California state government passed a bill banning local prohibitions on circumcision.

In Sweden, circumcision has been required to be performed under anesthesia ...

In May of this year, an appellate court in Cologne, Germany said, "A child's right to physical integrity trumps religious and parental rights." ...

... this debate appears to be heating up and, as with most questions that involve religion and public health, widespread agreement and resolution aren’t imminent. ... with uniformity or strict enforcement lacking, like in Germany and Sweden, confusion will ensue. And with confusion comes the potential for lawsuits.

Complications stemming from circumcision may have lifelong implications for the individual at the other end of the knife, no matter their age. A Jewish mohel or Muslim leader may not be sued, but should the law relegate this practice to your procedure room, urologists can expect a rise in medical liability insurance premiums akin to those paid by OB/GYNs.

Should physicians become the only game in town for circumcisions, it behooves urologists in particular to be prepared for potential pitfalls. After all, this is America. While our laws and court system won’t tolerate the barbaric and criminal acts perpetrated in South Africa or Indonesia, the right to an attorney and civil and criminal trial aren’t topics of debate.

Germany outlines new law allowing circumcision

(Reuters) - Germany's Justice Ministry has outlined a planned new law that will allow the circumcision of infant boys and end months of legal uncertainty after a local court banned the practice.

The ruling in June by a district court in Cologne outraged Muslims and Jews and sparked an emotional debate in the country, leaving an embarrassed government to promise legislation by the autumn protecting the right to circumcise.

Although the ban applied only to the Cologne region, doctors across the country refused to carry out operations because of what they saw as a risk of legal action.

The outline draft of a new bill states that the operation should take place "with the most effective pain relief possible" and only if parents have been fully informed about the nature of the procedure, a ministry spokesman said.

Generally doctors would carry out circumcisions but if the baby boy is less than six months old than it can also performed by another qualified person, such as a mohel, a Jewish individual specially trained in circumcising.

The ministry's outline bill, a first but critical step towards creating the new law, has been sent to Germany's federal states ahead of a consultation with experts due later this week.

Genital cutting tied to later abuse risk

NEW YORK (Reuters Health) - Women who underwent genital cutting as young girls may be at increased risk of physical, sexual or emotional abuse from their husband, a study of women in Mali suggests.

The study, of nearly 7,900 women, found that 22 percent of those with genital mutilation said they'd been physically abused by a husband or male partner. That compared with 12 percent of women who'd never been subjected to the procedure.

...

In the new study, researchers looked at whether there's a link between genital mutilation and a woman's odds of suffering abuse from her partner.

In Mali, where the vast majority of women have undergone genital mutilation, the government has taken steps to raise awareness of the consequences of the practice. But genital mutilation has not been outlawed.

The difficulty is that genital cutting is widely seen as an important cultural tradition, rather than a form of abuse.

"If something is entrenched in a culture, it is difficult to change," said Dr. Hamisu Salihu of the University of South Florida in Tampa, the lead researcher on the new study.

On the other hand, physically abusing your wife - though common in Mali and other African countries - does not have that cultural acceptance, Salihu told Reuters Health.

So being able to frame genital cutting in the context of domestic violence might help change people's views on the practice.

The study, reported in the obstetrics and gynecology journal BJOG, included 7,875 Malian women. The large majority - 6,919 women - had genital mutilation.

Of those women, 22 percent said they'd suffered physical abuse from their partner, while five percent reported sexual abuse and 12 percent emotional abuse.

When the researchers accounted for other factors - like education level and poverty - genital mutilation was linked to two- to three-fold increases in the risk of all three types of abuse.

One of the possible limitations of the study, according to Salihu's team, is that women were asked about sensitive issues. The actual levels of abuse may have been higher than women reported.

Past studies have suggested that across sub-Saharan Africa, half of all women have been abused by a husband or partner.

Salihu said these latest findings suggest that women with genital cutting may be in particular need of screening and counseling for abuse.

...

SOURCE: http://bit.ly/NCx4Kw BJOG: An International Journal of Obstetrics and Gynaecology, online August 24, 2012.

Child Welfare Legislation Outlaws Spanking

When Governor Jack Markell signed into law Senate Bill 234 on September 12, 2012, Delaware became the first state in the in the nation to effectively outlaw corporal discipline of children by their parents.

Sponsored by Senate Majority Leader Patricia M. Blevins (District 7), the legislation creates a definition of the term “physical injury” in the child abuse and neglect laws to include “pain.” Currently the law permits a parent to use force to punish a child for misconduct, but it prohibits any act that is likely to cause or does cause physical injury. By defining “physical injury” to include the infliction of pain on a child, spanking has become a crime in Delaware punishable by imprisonment.

Under the new law, a parent causing “physical injury” (e.g., pain) to a child under age 18 would be guilty of a class A misdemeanor and subject to one year in prison. A parent causing pain to a child who was 3 years of age or younger would be guilty of a class G felony and subject to two years in prison.

Home School Legal Defense Association opposed this bill as a violation of the right of parents to direct the upbringing of their children, including the long-recognized right to administer reasonable corporal discipline. HSLDA worked with the Delaware Home Education Association and the Delaware Family Policy Council in an effort to bring about a defeat of this legislation.

Genital Autonomy Under Attack

VANCOUVER, BRITISH COLUMBIA, Sep 21, 2012 (MARKETWIRE via COMTEX) -- From Sunday 30 September 2012 international experts will gather in Helsinki, Finland, to examine the human right of children to make their own decisions about the most private and personal part of their bodies.

Says Spokesman and Trustee of GA Richard Duncker: "Every day all over the world for many reasons adults cut, trim and re-shape the genitals of girls, boys and the often forgotten proportion of children born with indeterminate gender, intersex children - in almost every case without asking the child and with no medical need."

"Sometimes by surgeons in a modern hospital under anaesthetic," he says "Sometimes by lay people in a dusty village hut or a plush middle class apartment. In all cases the outcomes - good, bad or merely cosmetic - are permanent and affect the child's bodily experience for life."

In June 2012 a Cologne Regional Court (Landgericht Koln) decided medically unnecessary circumcision of a non-consenting child can be assault. Governments immediately mobilised to legalise these assaults on children in the name of religious freedom.

In August 2012 the American Academy of Paediatrics (AAP) echoed other peak medical bodies in declaring that circumcision of healthy boys should not be routine. Attention immediately turned to tax-funded government subsidies and foreign aid to pay for it.

How do scientists' own cultural or personal identity shape the questions they ask? Why are harms ignored in the search for benefits? Do parents use religion as an excuse for conformity? Why is there one rule for girls and another for boys? What degree of intentional pain and risk for children is unacceptable? How do we distinguish unnecessary surgery from child abuse?

Says Mr Duncker, "The science is controversial and incomplete. Religious beliefs of parents, researchers and legislators are a given. Children are People. How do they say: NO!"

These and other questions will be explored by speakers from all over the world, from different religious and cultural origins, including doctors, nurses, lawyers, and anthropologists as well as adults who still suffer the harms inflicted on them as babies.

Amish Sect Leader and Followers Guilty of Hate Crimes

By Erik Eckholm

Samuel Mullet Sr., the domineering leader of a renegade Amish sect, and 15 of his followers were convicted on Thursday in Cleveland of federal conspiracy and hate crimes for a series of bizarre beard- and hair-cutting attacks last fall that spread fear through the Amish of eastern Ohio.

The convictions of Mr. Mullet, along with several relatives and others from his settlement who carried out the assaults, could bring lengthy prison terms. The verdicts were a vindication for federal prosecutors, who made a risky decision to apply a 2009 federal hate-crimes law to the sect’s violent efforts to humiliate Amish rivals.

...

The victims “simply wanted to be left to practice their own religion in their own way in peace,” Steven M. Dettelbach, the United States attorney for the Northern District of Ohio, said in a news conference after the verdicts were announced. “The defendants invaded their homes, physically attacked these people and sheared them almost like animals,” Mr. Dettelbach said.

...

The testimony included an elderly woman’s account of her terror as six of her children and their spouses made a surprise late-night visit, with the men holding down her sobbing husband as they hacked off his beard and hair and the women cut her waist-length hair to above the ears as she prayed aloud.

...

To prove the most serious charges, the jurors had to be convinced that the defendants had caused “bodily injury,” which could mean “disfigurement,” and that the attacks were based mainly on religious differences. Lawyers for the defense argued that cutting hair was not disfigurement and that the attacks resulted from family and personal differences, including a bitter custody battle involving a daughter of Mr. Mullet’s, as well as disputes over the “true” Amish way.

...

[If cutting off hair is bodily injury and disfigurement, how can cutting parts of genitals off not be?]

Group protests pediatrics organization's stance on circumcision

By Eric Peterson

A group of local protesters called on the American Academy of Pediatrics to retract a recent statement supportive of infant male circumcision in front of the group’s Elk Grove Village headquarters Monday.

While the statement doesn’t recommend circumcision, it claims that its potential benefits outweigh the risks of harm.

The AAP’s position, as revised Aug. 27, is that the potential benefits — which include prevention of urinary tract infections, penile cancer and transmission of some sexually transmitted diseases — justify continued access to the procedure for families who choose it in consultation with their pediatrician.

Members of the AAP’s circumcision taskforce could not be immediately reached for comment Monday morning.

“This was a cultural statement, not a medical statement, from the AAP,” protester Dan Strandjord of Chicago said Monday morning.

He argued that it is largely cultural reasons and the fear of lawsuits that have maintained the practice of infant male circumcision in the United States long beyond its Victorian origins in the 19th century, Strandjord said.

He believes the “potential benefits” of circumcision mentioned by the AAP are akin to recommending the removal of breast tissue from girls as a means of preventing breast cancer.

Erica Wijenayaka of Elk Grove Village, who organized the protest, said the AAP’s statement makes no mention of the anatomical function of the foreskin for both male and female sexual partners.

What’s most continuing the practice in the U.S. to a degree no longer seen in most English-speaking countries and Europe is that fathers believe their sons should have the same procedure they had, Wijenayaka said.

She added that she would eventually like to see the procedure legally banned in the same way female circumcision is, and that even religious beliefs should not grant exceptions.

Strandjord said the AAP is the only medical organization in the world without a clearly defined position that doctors and parents shouldn’t be participating in this practice. He suspects there also is a profit motive keeping the practice alive, as the procedure costs between $400 and $600 and a surgeon can make $50,000 a year on circumcisions alone.

While some organizations have been fighting the practice of circumcision for 30 years, there has been a reduction in the percentage of male infants having the procedure, Strandjord added.

Wijenayaka said the movement is realistic about the pace at which such a cultural change can truly happen.

“We’re not going to end circumcision tomorrow through this protest, but we hope to put pressure on the AAP,” she said.

Pokot girls desert their homes, fear undergoing circumcision

Girls in Amudat District in north-eastern Uganda seek refuge from schools and authorities over forced circumcision.

By Steven Ariong

Sarah Cherot is playing a hide and seek game with a dozen other girls at Kalas Girls Primary School in Amudat District. The thrills and laughter that come from them echo through the empty classrooms as it is holiday time and the other students are at home.

Ms Cherot is one of 140 girls from the Pokot community in the district that have remained at school, refusing to go back to their homes for holidays fearing to be circumcised.

“Here, we are safe and do not have to worry about forced circumcision and marriage,” says 14-year-old Cherot, who is in primary five.

Cherot, together with a group of friends, escaped from their homes in Nabokotom Village in Amudat Sub-county in March this year when their parents were preparing them to face the surgeon’s knife.

“If you get a chance and watch the way a girl or a woman cries while going through the process, you will feel like to killing the surgeon that time,” she said.

The girls say they have lost many of their friends and relatives to the knife due to excess bleeding while others have remained disabled. ... It is carried out as a ritual to initiate young girls into womanhood. ...

In 2010, government passed the law against female circumcision after health experts found it was claiming many lives of expectant mothers and girls due to prolonged pregnancy. ...

Circumcision from a Child-protection perspective

Representatives of child protection bodies packed the National Conference Room in Berlin for a national press conference about the circumcision of boys:
Georg Ehrmann (CEO of the German Child Aid non-profit organization), Dr. Ulrich Fegeler (Presesprecher of the Professional Association of Children and Youth Physicians non-profit organization), Prof. Dr. Matthias Franz (Vice-Director of the Clinical Institute for Psychosomatic Medicine and Psychotherapy at the University Hospital, Düsseldorf), Eran Sadeh (founder of "Protect the Child", Israel) and Irmingard Schewe-Gerigk (CEO Land of Women non-profit organization). The video shows the entire first part (presentation of views) plus a declaration by Dr. Fegeler of the rights of the child.

Most of the presentations were in German, but that of Eran Sadeh from Israel was in English and Hebrew.

(Hebrew translated: I hereby call Jews in Israel and anywhere in the world: learn about the advantages of an intact penis, learn about the disadvantages of a cut penis, and join the unstoppable movement of tens of thousands of Jews all over the world who welcome their sons to the world without violating their bodily integrity, without hurting them, and without putting them at risk. There ends a year and its maledictions and a new one begins with its blessings. Happy New Year)

Liberia: In Sande Bush - Woman Bleeds to Death

Liberia's traditional school (Sande and Poro) authorities have vowed to continue with the practice despite the negative campaign from a few local and international groups for abolition.

Their commitment comes in the wake of report on the Voice of America (VOA) African service program Wednesday, suggesting that a 20-years old woman died in a sande bush after being circumcised in Nimba County.

The girl, (named with-held), according to the report, passed away at a local clinic where she was rushed from the bush as a result of profuse bleeding after the circumcision exercise.

In spite of that, authorities of those traditional schools (Sande and Poro) told the VOA that the practice was an inheritance from their ancestors long before Liberia's birth intended to prepare young women for home management and marriage, as well as to help women to give birth to more children.

Commenting on the issue, Varbah Gayflor, then Gender and Development Minister, said though the practice was age-old, it must be respected because it is the tradition and culture of the people. [A reason that is no reason at all.]

N.Y. Board Orders Forms for Circumcision Rite

The New York City board of health has voted unanimously to require parents to sign a consent form before allowing a mohel to perform metztizah b’peh, direct oral-genital suction during circumcision.

The vote was 9-0 to require parental consent for direct oral suction, a practice employed only by ultra-Orthodox mohels that can lead to transmission of a strain of herpes to which infants are especially vulnerable. Though transmission rates are believed to be low, If infected, babies can suffer brain damage or even death.

“We’re not banning the procedure, we’re not regulating how circumcisions are performed,” Jay K. Varma, deputy commissioner for disease control for the health department said after the meeting. “We’re simply requiring that people understand there is a risk, and if people want their baby to be circumcised, they have to understand that this procedure might potentially transmit an infection that is both serious as well as life threatening.”

There are no mandatory penalties imposed if the waivers are not signed. But the health commission may impose penalties at its own discretion. Varma said the department would respond to public complaints and investigate the claims, and that repercussions could range from a phone call or a formal warning letter, to fines of up to $2,000 for each violation.

Genital mutilation may not be isolated

The charging of four people over the circumcision of two young girls in Sydney has led to fears that other cases of female genital mutilation have gone undetected in NSW.

A sheik, a retired nurse and a man and woman have been charged over the genital mutilation of the girls, who were aged six and seven when the procedure was allegedly carried out in a home in metropolitan Sydney 18 months ago.

It is understood to be the first time anyone has been charged over the offence in NSW, with police alleging the procedure was carried out for cultural reasons.

Shabbir Vaziri, 56, a sheik from Auburn, appeared before Burwood Local Court on Thursday where he was granted bail.

He is charged with two counts of being an accessory after the fact to female genital mutilation and with hindering the police investigation.

Earlier on Thursday, a 68-year-old woman - a retired nurse - was charged with performing the procedure on the two girls.

A 42-year-old man and a 35-year-old woman were arrested last Friday and charged with two counts of female genital mutilation. Police have refused to confirm media reports the pair are the girls' parents.

Detective Superintendent John Kerlatec told reporters the girls were members of a small cultural community in Sydney and were still living in the family home.

"The children are still with their parents. I can stress that, despite this procedure, they are good parents," Det Supt Kerlatec said.

...

Asked if he thought there may be more victims, Det Supt Kerlatec said: "We're not aware of any other incidents at this stage, but I can't discount that fact."

NEW YORK (JTA) -- Agudath Israel of America reportedly is planning to sue the city of New York if its health department passes a law requiring parental consent for the circumcision ritual known as metzitzah b'peh.

The New York Jewish Week reported the development based on an email forwarded to the news outlet sent originally from the account of Agudah's general counsel, Mordechai Biser. According to the e-mail, the haredi Orthodox group is seeking a New York law firm that would work pro bono or on “a reduced rate basis” to bring “a lawsuit against the City of New York to prevent the City from issuing a regulation that would require written parental consent for an aspect of bris milah (‘metzitzah b’peh’).”

The city is expected to pass the measure this week requiring parents to sign off before the direct oral suction procedure. ...

A statement by the Orthodox Rabbinical Council of America on Monday noted that "Many Jewish legal authorities have ruled that direct oral suction is not an integral part of the circumcision ritual and advocate the use of a sterile tube to preclude any risk of infection." Like Agudah, however, the RCA expressed opposition to the proposed measure, citing "concern about government regulation of religious practices."

“There is no safe way to perform oral suction on any open wound in a newborn,” Samantha Levine, a spokeswoman for New York Mayor Michael Bloomberg, told The Jewish Week via e-mail Monday, citing leading medical authorities.

FGM practitioners 'have stopped thinking about why they do it'

Many people who carry out female genital mutilation (FGM) no longer consider precisely why they are doing it, an academic has stated.

According to Dr Anne Aly of Curtin University in Australia, the practice is generally believed to "be a cleanliness thing", similar to how male circumcision is "done to prevent infection".

Speaking to WAtoday, she noted that FGM is also performed in order to prevent women being too sexually active.

However, Dr Aly said that in places where the procedure is still carried out, these issues are not necessarily considered and that the actions of those who perform FGM are dictated largely by tradition.

"When you have a tradition that has been practiced for years, people stop thinking about why they do it," she observed.

Dr Aly added that FGM "pre-dates all religion" and is particularly common in Egypt and the Republic of Djibouti.

According to the World Health Organization, the procedure can often lead to complications during childbirth, as well as urinary problems, infertility and cysts.

Appeals court to weigh penis amputation verdict

By Brett Barrouquere

FRANKFORT, Ky. -- The Kentucky Court of Appeals is set to hear oral arguments in the case of a man whose penis was amputated during what was scheduled as a circumcision.

Arguments are set for 10 a.m. EDT Tuesday in Frankfort. A Shelby County jury in 2011 ruled in favor of Dr. John Patterson of Louisville, who had been sued by Phillip Seaton of Waddy in 2008. Seaton alleged that Patterson unnecessarily amputated his penis and that the surgery was never authorized.

Seaton says he went in for a circumcision and wasn't given an opportunity to seek a second opinion before the amputation.

Patterson told jurors he had permission to perform any medical procedure deemed necessary and that the doctor found cancer in the organ during the surgery.

AAP ethicist misrepresents circumcision's role in death

The ethicist for the American Academy of Pediatrics has mis-stated the role of circumcision in a baby's death.

On radio KQED, he said the family of a very sick baby had wanted him circumcised before he died.

Yet the baby's mother had blogged, while he was still struggling for life against a circumcision-caused haemorrage, "I almost killed my baby".

The baby was born in Indiana in August 2010 with a major heart defect, virtually half his heart missing. He underwent heart surgery three days later. In October, the hospital told his mother he was well enough to be circumcised, but they nicked an artery and he died the next day.

The doctor came in this morning and asked if we wanted to get it done today. I said yes....

I should have known better. I should have said no. I had hoped that he would do well and that it wouldn't be such a big deal. But instead, I almost killed my child by consenting.

... Why did I have to say yes?

Clearly, she was desperately hoping and praying her son would live (of course).

On Radio KQED on August 29 2012, the ethicist for the American Academy of Pediatrics, Dr Douglas Diekema, grossly misstated the case, portraying the mother as abandoning hope (starting at 12:40):

"There's at least, y'know, one of these cases that gets trotted out, involved a very sick baby that was likely to die anyway, and his parents wanted him circumcised before, ah, his death, and to attribute that to a circumcision is silly, um, that kind of a death."

His mother's blogs give the lie to that interpretation. [She has since removed all reference to circumcision from her blog.]

Intactivists were accused at the time of exploiting the baby's death, after several had urged her not to circumcise, and berated her afterwards. Dr Diekema seems to be exploiting it in a much more cynical way, attributing to the mother a callous disregard for the baby's life and health.

Salon des Refusés

September 10, 2012

The AAP gets letters - but so far, doesn't publish them

By Hugh Young

The American Academy of Pediatrics' publication, Pediatrics has been treating e-letters in reaction to its policy on circumcision very oddly.

The policy came out at midnight (ET) on August 27, 2012. In the following weeks, several letters have appeared, mainly critical of the policy (previously here (technical report in HTML), previously here (Policy statement "early") and still here (Policy statement) as of September 13, 0510 ET).

But more hard-hitting letters, despite being fully referenced, have not appeared, and others have been added and removed in capricious ways.

The long awaited circumcision policy statement from the American Academy of Pediatrics (AAP) may be most notable for what it does not address. The statement steadfastly omits any analysis of the foreskin, its erogenous, protective, and immunological functions, or crucially, the impact its removal has on normal sexual functioning and on the health and quality of life.

The AAP's Task Force on Circumcision ignores a child's well-established human and legal rights to decide for himself at an age of understanding whether he wants to part with his foreskin. Instead, the Committee says-with more honesty than ethics--that the common reluctance of an older child or adult to be circumcised justifies parents forcing a partial penile amputation upon him at an age when he is too small to effectively resist.

Male circumcision violates a child's right to bodily integrity, not to mention numerous civil and criminal laws. Malpractice awards are mounting up, including a recent $700,000 settlement reported in the Massachusetts Lawyers Weekly. The AAP's repeated suggestion that, "In most situations, parents are granted wide latitude in terms of the decisions they make on behalf of their children" badly misstates the law. In fact, starting in 1944 with Prince v. Massachusetts, courts have repeatedly affirmed that: "Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves."

Additionally, and perhaps even more egregiously, the AAP's policy statement contradicts its own bioethics policy statement, which affirms that parental wishes cannot justify unnecessary surgery and that "providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses." Moreover, according to this same bioethics policy statement, a "pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent."

One puzzling aspect of the AAP policy statement is a contradictory dance performed on the question of how strong the alleged benefits of the procedure are. On the one hand, there is no recommendation for universal neonatal circumcision, and it is admitted-as it previously stated in its 1999 policy statement--that the "health benefits are not great enough to recommend routine circumcision of all male newborns." Moreover, nowhere are the benefits and risks numerically compared, and the AAP repeatedly states that complication data is unknown. How then can it rationally conclude that, "Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks…?" And how can pediatricians be tasked by the AAP to "assist parents by explaining in a nonbiased manner, the potential benefits and risks…" despite the fact that the AAP says the risks are unknown?

The US has both the highest rate of circumcision and the highest rates of HIV and AIDS in the industrialized world, so a claim that the first can prevent the other two doesn't pass the smell test. The AAP admits as much by saying that "key studies to date have been performed in African populations with HIV burdens that are epidemiologically different from HIV in the United States." Moreover, the African studies were closer to a lowest common denominator than a "gold standard," suffering from numerous critical flaws including selection bias, randomization bias, experimenter bias, inadequate blinding, supportive bias, participant expectation bias, lack of placebo control, inadequate equipoise, attrition of subjects, failure to investigate non-sexual HIV transmission, lead time bias, and time-out discrepancy. Additionally, the "60%" figure refers to the relative risk and seems calculated to deliberately mislead; the absolute risk reduction is only a measly 1.3%. As the AAP itself concedes, given vast differences in health conditions and modes of transmission between the US and Africa, the results can hardly justify infant male circumcision in the United States. Babies don't get HIV and AIDS from sexual contact.

In fact, not a single study has ever proven that circumcision has actually decreased any disease in the United States. Over a hundred boys die each year from this needless procedure, yet the AAP fails to attach much significance to the deaths stemming from the practice. Rather than objectively evaluating all available evidence, the AAP selectively quotes and references highly contested and controversial studies to attempt to justify an entrenched yet outmoded cultural-not medical-practice.

We were surprised to witness the reappearance of disproven justifications for circumcision such as urinary tract infections (UTIs), penile cancer, and even syphilis. The AAP also ignores the showing by Chessare that even if claims about UTIs are valid, the complications from the procedure exceed the benefits in preventing UTIs.

From there, matters become even more interesting and even less defensible. The AAP fancifully claims at several points, using slightly different language, "It is reasonable to take these non medical benefits and harms for an individual into consideration when making a decision about circumcision." In fact, few things are less reasonable and more unprecedented than physicians making medical decisions based on non-medical factors and vagaries of their infant patients' parents' culture and religion as central to whether to do a procedure. It is ironic that harms are improperly mentioned here but not properly discussed elsewhere. The other procedures that get cultural validation when medical basis is lacking can be counted on the fingers of zero hands.

Moreover, a huge logical hole appears when the policy statement suggests that, "Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families." One cannot coherently argue that circumcision is elective and of variable value at the individual level yet terribly important in a larger public health context.

The AAP selects, sometimes out of context, bits of language that seems to lend its position support, and completely ignores contradictory data. Thus the policy statement cites a study that proves that male circumcision removes the most sensitive part of the penis, then proceeds to ignore that inconvenient truth. The policy statement cites a study suggesting that circumcising men actually increases the HIV risk to heterosexual women and similarly ignores that uncongenial finding. Another study is introduced as evidence for circumcision helping prevent HIV, yet the AAP omits to mention that it also demonstrates that intact males who wait at least ten minutes after intercourse before wiping have a much lower rate of contracting HIV than do circumcised men. The policy statement cites a study showing that smoking and a narrow foreskin, not a normal one, contribute to penile cancer, yet the AAP ignores those findings as not supporting the circumcision juggernaut.

We question why the AAP is effectively recommending an unnecessary surgery at a time when the US faces a crisis in not being able to provide even necessary care for all our children. As was just demonstrated in a report by the Institute for Medicine, an astonishing $750 billion is wasted on health care each year in this country. Recently it was estimated that close to $2 billion of that amount may arise from this unnecessary and harmful procedure. In these days of rising medical costs and scarce resources, we simply cannot afford to continue to carry out such a harmful and outmoded practice.

Given the many virtues claimed for male circumcision by the AAP, one may be forgiven for wondering why European men are not falling down dead in the street and are even enjoying better health indicators than American men including in the areas the statement cites as improved after circumcision? Neonatal circumcision is a gross violation of children's rights. It inevitably causes pain when performed on infants, amputating tissue having erogenous, protective, and immunological functions. The AAP should immediately retract its policy statement and replace it with a document reflecting such critical concerns as the functions of the lost tissue and the importance of respecting non-consenting children's rights.

George Hill, John GeiskekerDoctors Opposing Circumcision

The recent statement of the AAP Task Force on Circumcision rendered a disservice to the thousands of honest and hard-working pediatricians across the US, while benefiting mostly obstetricians.12 It did nothing to enhance the reputation of pediatricians as advocates for their child patients.

Circumcision is in such deep decline -- near single digits -- in other Anglophone countries that this obsolete 19th century intervention will entirely disappear there in the next generation, if not earlier. Those countries -- the UK, Canada, Australia and New Zealand, have healthy children who enjoy universal health care without circumcision, and more to the point, lower STD and HIV infection rates than the USA.

The incidence of non-therapeutic male circumcision in America has been declining for years and now stands at about 54 percent, the lowest incidence since the early 1930's. Genital integrity has become the norm in twelv
e states and stands poised to become the norm in America.

Unfortunately, the members of the Task Force, whose personal, religious, cultural, and institutional ties suggest obvious pro-circumcision bias, merely represented the commercial wishes of the three medical groups that profit the most from circumcision. The AAP statement can be read as a transparent, last-ditch, self-serving effort to reverse the trend toward genital integrity for America's boys and merely shore-up the revenue stream from a declining cultural practice.

Normal Anatomy. The task force declined to provide crucial information on the structure, composition, and physiological function of the human foreskin -- the healthy and highly nerve-supplied tissue amputated by circumcision -- although the information is readily available in excellent reviews.3-4 This discussion is wholly material to a decision regarding male circumcision. Even had the Task Force wished to denigr
ate normal, healthy, human anatomy, it was incumbent on them to do so on the record.

HIV in Africa. The centerpiece of this action was to be the three early-terminated trials that were carried out on adult males in sub-Saharan Africa, published in 2005 and 2007. Unfortunately for this scheme, these three RCTs have now been thoroughly vetted and debunked,5-10 although the authors of the Circumcision Policy Statement chose to ignore these findings.2 Furthermore, a new large-scale study from Puerto Rico finds more STDs and HIV infection in circumcised men.11 The new evidence indicates that HIV infection in America will increase if the recommendations contained in this new statement are implemented.

Urinary Tract Infection. In addition to the specious HIV claim, the task force resurrected ancient claims about urinary tract infection, which are based on methodologically flawed, retro
spective studies conducted nearly 30 years ago. Chessare demonstrated twenty years ago that the risks exceed the benefits; however the task force ignored his findings.12

Furthermore, the task force misrepresented the meta-analysis by Singh-Grewal et al., which found that "the benefit of circumcision on UTI only outweighs the risk in boys who have had UTI previously and have a predisposition to repeated UTI."13 More pointedly, a Canadian physician writing in the Canadian Medical Association Journal stated '"Circumcision prevents UTI the way garlic prevents vampires." 14

HPV. The task force tried to show that circumcision reduces HPV infection while ignoring the increasing use of a very successful HPV vaccine.15

Errors of Bioethics/Limits of surrogate consent. The authors assert that parents have a right to consent to circumcision. This originated with an erroneous applicat
ion of the law of surrogate consent for therapeutic operations to non-therapeutic operations that was made by the ad hoc committee of four physicians in 1975 (apparently without benefit of legal counsel) and has been repeated ever since.16 The task force also improperly relies on a guidance for the treatment of dying children,17 which is inapplicable to the treatment of healthy boys.

U. S. courts do not recognize that parents have an unfettered right to consent to the intentional injury of children by non-therapeutic operations.18-21

Conclusion. This new circumcision policy statement promises to bring even more embarrassment and discredit upon the AAP than the infamous 1989 statement, which recommended withholding pain relief for boys undergoing circumcision.22

The board of directors of the American Academy of Pediatrics has an ethical duty to vacate this statement immediately be
fore it can be implemented.23 Failure to do so is likely to increase HIV infection in the United States 9-11 when circumcised boys become sexually active without the immunological protection of their missing foreskins,3 -- or worse, feel over-confident that they cannot contract STD's based on the statement.

Our international educational organization recommends that the American public reject this statement as biased, unethical, and unwarranted by evidence-based medicine.24

"Benefits of Circumcision Are Said to Outweigh Risks" (page A2, August 27) presents a balanced review of the recent report of The American Academy of Pediatrics. This report leans heavily on "evidence" of H.I.V. transmission in Africa. While the HIV/AIDS crisis in Africa is of epidemic proportion, this bears little relationship to newborn foreskins. A decision by American parents to circumcise their sons based on African studies is senseless.

With the exception of ritual circumcision in Judaism and Islam, the incidence of newborn circumcision in Europe is negligible. Europeans have long understood the overwhelming trauma that circumcision brings to infant boys and the men they are to be. The United States needs to join the majority of the civilized world and stop circumcising their newborns.

Mark D. Reiss, M.D.

Executive Vice President, Doctors Opposing Circumcision

Culturally biased and badly flawed

Hugh YoungIndependent researcher, unaffiliated

The American Academy of Pediatrics policy on male genital cutting is culturally biased and seriously flawed. It should be withdrawn.

It fails to consider the structure or functions of the foreskin, a normal healthy body part, only the cutting of it off. It does not, for example cite Taylor's groundbreaking 1996 paper1. The erogenous value of the foreskin has been known for millennia, even to its enemies.2 Recent denial of that value is confined to those who have no experience of it.

It bases its conclusions about sexuality on two physiological studies that did not consider the foreskin and on surveys of African adult volunteers for circumcision in the context of HIV prevention.

It pathologizes normal intact penile concomitants, separation of the prepuce from the glans after two months (it can take as long as 17 years) and preputial wetness.

It is filled with confirmation bias - finding the results the authors want.

It claims benefits of circumcising outweigh the risks without ever numerically comparing them.

It exaggerates benefits and minimizes risks and harm: For example -

It cites a study showing that "circumcision ablates the most sensitive part of the penis" and ignores that finding.3

It admits the African HIV findings may not be applicable to the USA, but goes ahead and applies them.

It cites a study suggesting circumcising men increases the HIV risk to women, and ignores that finding.4 (That study was called off "for futility" - an increased risk of HIV transmission apparently of no interest to the researchers - before it could reach statistical significance.)

It cites a study showing that a narrow foreskin (phimosis), not a normal one, is the issue in penile cancer, and ignores that finding.

It dismisses major complications and death from circumcision because it did not find any statistical studies of them.

It discusses the action of the Mogen circumcision clamp without mentioning that the clamp has caused too much of several boys' penises to be cut off; lawsuits have driven the company out of business.7

It repeats the common claim that it is safer to circumcise babies than adults, but offers no evidence for that claim.

Its discussion of the ethical question of removing genital tissue from a non-consenting person versus leaving it for him to decide assigns no value to his autonomy or his human right to bodily integrity.8It compares the costs of doing it early vs late, but not the benefits of not doing it at all.

Its ethical consultant has said elsewhere that circumcision is not necessary and has a risk of harm, and that (quoting the AAP's own bioethics policy) a parental wish is not sufficient to justify doing any surgery, and it ignores that.9,10

The AAP withdrew its female genital cutting policy after a storm of outrage two years ago, when it proposed allowing a token ritual nick to baby girls, "much less extensive than neonatal male genital cutting" (my emphasis). Since that was unacceptable, how can this be acceptable?

The public mood is turning against infant circumcision. The Intactivism movement has found a receptive audience, especially among young people through social media. The AAP's policy seems bent, not on considering the healthy intact penis at all, but on restoring insurance and public funding to circumcision in order to find a new market among the poor. It does a disservice to the growing number of boy babies being left intact, and their parents - and an even greater disservice to the boys who will be circumcised as a result of its strident advocacy, and to the men they become.

I am annotating the policy further here: http://www.circumstitions.com/Docs/aap-12-anno.pdf

Hugh Young, BSc

References:

1. Taylor, J.P., A.P. Lockwood and A.J.Taylor The prepuce: Specialized mucosa of the penis and its loss to circumcision Journal of Urology (1996), 77, 291-295

8. For example, Sir William Blackstone: "Besides those limbs and members that may be necessary to man ... the rest of his person or body is also entitled by the same natural right to security from the corporal insults of menaces, assaults, beating, and wounding; though such insults amount not to destruction of life or member...." - Commentaries on the Laws of England. 1765

The new 2012 AAP Circumcision Policy Statement should be rescinded
immediately. Below are enumerated some of the serious problems with
this new statement.

The Abstract states on page 585 that "health benefits are not great
enough to recommend routine circumcision for all male newborns", but
this is not repeated even once in the long text on pages 758-785.

Other long columns favoring circumcision, however, are repeated over and
over again, on pages 761-762, 770, 775-776, and 778. The 1999 AAP Statement
was 8 pages long (pages 686-693), but this diatribe against living
with a foreskin goes on for 28 pages. There is almost the feeling that the
AAP hopes that if it keeps repeating something over and over again,
eventually it might become true.

The AAP on page 772 admits that "the true incidence of complications
after newborn circumcision is unknown". "(T)here are no adequate
studies of late complications in boys undergoing circumcision in the
post-newborn period; this area requires more study." (page 773) "There
are not adequate analytic studies of late complications in boys
undergoing circumcision in the post-newborn period." (page 774) Under
"Stratification of Risks" the AAP says, "Based on the data reviewed,
it is difficult, if not impossible, to adequately assess the total impact
of complications, because the data are scant and inconsistent
regarding the severity of complications."

After all these admissions, the AAP then has the audacity to conclude
that "the health benefits of newborn male circumcision outweigh the
risks". (page 756). If one doesn't know how often complications occur,
then one can't make the judgment that the benefits outweigh the risks!
The AAP lacks the evidence it needs to make such a claim, and the
claim is bogus.

Under "Task Force Recommendations" (page 775), the AAP says,
"Physicians counseling families about elective male circumcision
should assist parents by explaining, in a nonbiased manner, the potential
benefits and risks ..." The AAP doesn't know the incidence of risks,
but it expects physicians to know the unknown.

The 1999 Statement studied 40 years' worth of research, and the 2012
studied only selective research since 1999. Only 1031 of 1388 studies
were accepted to look at. Balance might have been found in the 357
studies that were omitted, but the AAP was not seeking balance. The
AAP statement goes on ad nauseum about alleged "benefits", to the point of
fear-mongering that something will go wrong if an infant isn't
circumcised. It's a high pressure sales pitch to try to get the
American public to buy the circumcisions that AAP and ACOG doctors are
selling. This is in direct contrast to Europe, where circumcision is
uncommon and the health of European children equals or surpasses that
of American children.

No studies on ethics were included in this statement, and it is clear
that the rights of the child and how a grown man might feel about
having had HIS foreskin stolen from him as a defenseless child were
never given any consideration at all by the AAP. These are major
issues, and even more important than many of the other issues the AAP
discusses. Material was provided to the AAP to study this aspect of
circumcision, but it was ignored. With one bioethicist on the panel,
the AAP might at least have given the ethics of circumcision a cursory
examination, considering that they were provided with many sources
showing the emotional distress many men feel. Ethics, however, did not
enter the picture for the AAP. Respect for the bodily integrity of
another person was not included, and medical ethics were thrown out
the window as infants were thrown under the bus.

The AAP now pushes for third-party reimbursement of non-therapeutic
circumcision, at the expense of taxpayers during budget crises and
deficits. Other countries don't waste money on unnecessary
circumcisions, but the AAP wants Medicaid and private insurance to
subsidize unnecessary circumcisions. Wasteful spending drives up
medical costs for everyone. The cost for circumcision on page 777
ranges from $216 to $601 per circumcision in the U.S. In 2010, the
in-hospital U.S. circumcision rate was 54.7%. Thus, 45.3% of newborn
males left the hospital genitally intact. If the AAP were to convince
parents of these 45.3% to circumcise (as they are attempting to do in
this 2012 statement), then there would be 45.3% of roughly 2.1 million
baby boys that could be an additional income source for physicians.
This would be an additional 951,300 male infants to profit from. At
prices the AAP quotes, this could mean an additional $205,480,800 to
$571,731,300 for doctors who circumcise. There is a clear financial
conflict of interest among AAP Task Force members who circumcise.

Between $205 and $571 million is no small sum for physicians, and as
Thomas Wiswell, M.D. (who appears several times in the References)
stated on June 22, 1987 in the "Boston Globe", "I have some good
friends who are obstetricians outside the military, and they look at a
foreskin and almost see a $125 price tag on it. Each one is that much
money. Heck, if you do 10 a week, that's over $1,000 a week, and they
don't take that much time. "(Lehman 1987) Money like that would
certainly help doctors make their mortgage payments, car payments, pay
for vacations, etc. - a financial "benefit" the AAP failed to mention.
Under Literature Search Overview, it is understandable why AAP
physicians might consider it important to investigate "What are the
trends in financing and payment for elective circumcision?"

No studies on the anatomy and functions of the foreskin were included.
It is common sense to consider what the functions of a healthy body
part are before amputating it. Probably because the male AAP Task
Force members are all circumcised, this idea was difficult for them to
grasp. Only one study on the sexual impact of circumcision was included, and
this from Africa. Other studies were ignored or discounted.

"The effect of male circumcision on the sexual enjoyment of the female
partner", which appeared in BJU INTERNATIONAL, Volume 83, Supplement
1, Pages 79-84, January 1, 1999, is not mentioned. Nor is the newest
Danish study that was publicized on November 14, 2011 - "Male
circumcision leads to a bad sex life" - "Circumcised men have more
difficulties reaching orgasm, and their female partners experience
more vaginal pains and an inferior sex life, a new study shows." See:
http://sciencenordic.com/male-circumcision-leads-bad-sex-life The AAP
had time to include this study, but it was ignored. "Sexual
Satisfaction and Sensitivity" (page 769) never once mentions or
considers how circumcision impacts the sexual experience for females.
The AAP gets it totally wrong about males, and then totally ignores
females!

People sent material to the AAP about CIRCUMserum, Senslip, and
foreskin restoration for men trying to undo some of the damages of
circumcision and improve their sexual experience and that of their
female partners. It didn't fit the Task Force's pro-circumcision
agenda, so it was ignored. The Policy Statement is totally lacking in
ethics and information about the anatomy and functions of the
foreskin. Instead, the Task Force is more interested in training more doctors to
circumcise and in how to do so with different devices and various
forms of anesthesia.

The physical and sexual harms from circumcision are minimized or
dismissed outright. Deaths from circumcision and botched circumcisions
are considered "case studies", and children horribly damaged from
circumcision aren't very important to the AAP, despite its claim that
it is "Dedicated to the Health of All Children". When cribs are faulty
or car seats aren't safe, the AAP becomes concerned and warns parents.
When physicians botch circumcisions and are at fault, children don't
matter.

After one botched circumcision lawsuit in 2010 and a $10.8 million
award, the company that manufactured the Mogen clamp went out of
business. The AAP report should have advised physicians to NOT use the
Mogen clamp because of the botched circumcisions that have resulted
with this device. If still in use, no doubt there will be future
tragedies with the Mogen clamp, but parents will only be able to sue
the doctor and hospital and not the manufacturer. See:
http://www.ajc.com/news/nation-world/atlanta-lawyer-wins-11-573890.html

There is so much reliance on studies from Africa in this statement
that it seems like the AAP should change its name to the African Academy of
Pediatrics. In contrast to the AAP, the American Association of Family
Physicians (AAFP) has stated: "...the association between having a
sexually transmitted disease (STD) - excluding human immunodeficiency
virus (HIV) and being circumcised are inconclusive... most of the
studies ...have been conducted in developing countries, particularly
those in Africa. Because of the challenges with maintaining good
hygiene and access to condoms, these results are probably not
generalizable to the U.S. population". But generalize the AAP did! In
addition, the AAP listed page after page of STDs that allegedly
circumcision would prevent. A recent study in Puerto Rico found that
circumcised men have HIGHER rates of STDs and HIV, but this wasn't
included. See: http://www.ncbi.nlm.nih.gov/pubmed/22897699

The 60% reduced risk of HIV following circumcision is a relative risk
reduction, not the absolute risk reduction. "Across all three
female-to- male trials, of the 5,411 men subjected to male
circumcision, 64 (1.18%) became HIV-positive. Among the 5,497
controls, 137 (2.49%) became HIV- positive", so the absolute decrease in HIV
infection was only 1.31%, which is not statistically significant."
(Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into
male circumcision and HIV transmission: Methodological, ethical and
legal concerns. J Law Med 2011; 19:316-34.)

Infants are not at risk of STDs or HIV through sexual contact, so this
speculation about their future risk is foolhardy. Infants might also
be at risk for many other diseases, but surgical amputation of healthy
body parts is a foolhardy approach for the prevention of disease. That
is not good medicine. If an infant is at risk of an STD, then it is
probably safe to say that an adult is perpetrating a crime against the
child and needs to be arrested and charged.

Judaism and Islam are mentioned as religions that practice religious
circumcisions. Once again, the new AAP statement ignores Christianity,
which teaches that circumcision is unnecessary. Christianity is the
largest religion in the U.S., but its teachings don't even get a
mention by the AAP. With an over-representation of members on the Task
Force who have a religious bias favoring circumcision, they don't seem
concerned that their endorsement of circumcision goes against the
religious beliefs of others.

The AAP promotes parents choosing medically unnecessary circumcisions
for their male children, completely contradicting what it said in
PEDIATRICS, Volume 95 Number 2, Pages 314-317, February 1995. It said
then, "Thus "proxy consent" poses serious problems for pediatric
health care providers. Such providers have legal and ethical duties to their
child patients to render competent medical care based on what the
patient needs, not what someone else expresses. . . the pediatrician's
responsibilities to his or her patient exist independent of parental
desires or proxy consent."

Parents deserve factual information about circumcision, but they won't
find it in the new AAP Statement. In fact, the AAP wrongly advises
parents of intact boys to retract the foreskin and wash under it with
soap and water. (page 763) Soap can alter the good bacteria under the
foreskin, potentially causing infections that should then be treated
with liquid acidophilus to restore the good bacteria. Water is
sufficient for cleansing. Circumcised doctors with circumcised sons
probably don't know this, just as they know nothing about the value of
the foreskin.

On page 764, the AAP speculates that the foreskin contains a high
density of Langerhans cells, "which facilitates HIV infection of host
cells." Actually, the exact opposite is true. "Langerin is a natural
barrier to HIV-1 transmission by Langerhans cells" (Nature Medicine- 4
March 2007). This study states, "Langerhans cells (LCs) specifically
express Langerin . . . LCs reside in the epidermis of the skin and in
most mucosal epithelia, such as the ectocervix, vagina and
foreskin."

The incidence of UTIs can be reduced through breastfeeding, which the
AAP says it supports. This is nowhere mentioned under "Male
Circumcision and UTIs" on page 767. HPV can be prevented with a
vaccine for both boys and girls, but it is not mentioned on that page. A
recent study reporting on the large number of re-circumcisions done following
infant circumcisions is also not mentioned (another costly risk
ignored by the AAP). On page 770, EMLA is mentioned as a possible anesthetic,
but EMLA is not supposed to be used on infants. Unnecessary surgery
performed with anesthesia still remains unnecessary surgery.

Under "Ethical Issues" (pages 758-759), two of the references for this
opinion come from Douglas Diekema, M.D. who signed his name to this
statement as well as to the 2010 AAP statement endorsing ritual
genital nicks of females. The rights of the child are totally ignored in this
section, and religious and cultural beliefs for circumcision are
touted. This is Diekema's personal opinion that the Task Force bought
into, based upon what he wrote before. It is at odds with what the
AAP's own Committee on Bioethics wrote in January 1988- "The
constitutional guarantees of freedom of religion do not sanction
harming another person in the practice of one's religion."
Circumcision does and has harmed children.

Under Ethics, references are taken from M. Benatar and D. Benatar
(both Jewish circumcision defenders), as well as from AR Fleishman (who
probably has a religious bias favoring circumcision). Under "Ethical
Issues" (page 759), there's an interesting choice of words by the AAP.
"In cases, such as the decision to perform a circumcision in the
newborn period ... and where the procedure is not essential to the
child's immediate well-being", the AAP admits here that circumcision
"is not essential". It even calls circumcision "elective" in several
places, but it then proceeds to do a massive sales pitch for
unnecessary circumcisions.

Under Ethics, Reference #14 comes from the British Medical
Association- "The law and ethics of male circumcision: guidance for doctors: J. Med
Ethics 2004. The BMA did not print a favorable piece on circumcision,
but the AAP cherry-picked something from it on page 760. Medical
associations in other countries, like the British Medical Association,
do not endorse circumcision as the AAP has so foolishly chosen to
do.

On page 760, the AAP states, "The Task Force's evidence review was
supplemented by an independent, AAP-contracted physician and doctoral-
level epidemiologist who was also part of the entire evidence review
process." Why is this doctor's name not even mentioned or listed
alongside the Task Force members? The AAP should be open and reveal
the name of this person they paid to play such a significant role.

Several times in the report, the AAP states (page 762), "For parents
to receive nonbiased information about male circumcision in time to
inform their decisions...clinicians need to provide this information at least
before conception, and/or early in the pregnancy, probably as a
curriculum item in childbirth classes." There is absolutely no way
doctors can do this before conception. "Inform their decisions" sounds
like code words for brainwashing parents, a form of mind control
sanctioned by the AAP!

The AAP on page 763 uses the term "Uncircumcised" under "Care of the
Circumcised Versus Uncircumcised Penis", and later the term "non-
circumcised". The correct terminology is intact penis, or normal or
natural penis. We don't say "uncircumcised" female or
"non-circumcised" female.

The APP on page 764 states, "Mathematical modeling by the CDC shows
that, taking an average efficacy of 60% from the African trials,
[Note: the relative risk versus the much lower absolute risk] and assuming
that protective effect of circumcision applies only to heterosexually
acquired HIV", etc." The AAP states here that they are "assuming",
which means to "suppose to be the case, without proof." There's a
saying that goes if you "assume" anything, it makes an "ass" out of
"u" and "me". Assumptions are not evidence, but the AAP relies upon
assumptions.

"Analgesia and Anesthesia for a Circumcision After the Newborn Period"
(page 771) states, "Additional concerns associated with surgical
circumcision in older infants include time lost by parents and
patients from work and/or school." The AAP is promoting newborn circumcision so
parents don't have to miss work? Parents miss work all the time when
their children get sick as toddlers and later on. Now, with its
misplaced priorities, the AAP is concerned about parents missing work,
but not concerned about the rights of the child.

Under "Complications and Adverse Events" (page 772), the AAP twice
mentions how circumcision risks are lower in hospitals with trained
personnel than with those performed by untrained practitioners in
developing countries. U.S. parents don't live in a developing country,
so this doesn't belong in the AAP statement!

The AAP sings its own praises under "Medical Versus Traditional
Providers". "Physicians in a hospital setting generally have fewer
complications than traditional providers in the community setting."
Was this the AAP saying that doctors are safer than mohels? I don't
think they'll like that!

In 2009, ten years after the AAP did not recommend circumcision (and
still doesn't apparently, if one reads the words on page 585 that are
almost hidden), their own survey of AAP members found that "18%
responded recommending to all or most of their patients' parents that
circumcision be performed." (page 776) It's not surprising that AAP
doctors would recommend a surgery that means more money for them. On
pages 777-778 the AAP wants to know about the effectiveness of their
new 2012 statement. "The Task Force recommends additional studies to
better understand ... The impact of the AAP Male Circumcision policy
on newborn male circumcision practices in the United States and
elsewhere." In other words, how effective can the AAP be in deceiving
and misleading American parents about circumcision, and people in
other countries as well? The AAP may discover that educated parents are on
to them.

The AAP wants to work with the ACOG, AAFP, American Society of
Anesthesiologists, and American College of Nurse Midwives to develop a
plan about which groups are best suited to perform newborn male
circumcisions. (page 777) In other words, how is the AAP going to
secure its share of the money it wants from amongst all these
groups?

The AAP targets blacks and Hispanics in the U.S. for unnecessary
circumcisions. "African-American and Hispanic males in the United
States are disproportionately affected by HIV and other STIs, and thus
would derive the greatest benefit from circumcision." (page 777) But
then, under Areas for Future Research, the AAP says, "The Task Force
recommends additional studies to better understand ... The impact of
male circumcision on transmission of HIV and other STDS in the United
States because key studies to date have been performed in African
populations with HIV burdens that are epidemiologically different from
HIV in the United States." The AAP just spent several pages before
this promoting newborn circumcision to allegedly prevent STDs and HIV based
on African studies, but now it's admitting that more studies are
needed because the results could be different in the U.S. Was this put in to
help with the solicitation for more funding for pro-circumcision
researchers at Johns Hopkins and elsewhere, to keep them going?

When asked if the RCTs would be repeated in the U.S. at the 2009
National HIV Prevention Conference in Atlanta, Dr. Katrina Kretsinger
of the CDC replied that they would not, because it would be unethical
to do so! If these studies would be unethical to do in the U.S., then
how were they ethical to do on black men in Africa?

The AAP does say one good thing. On page 760 the AAP says, "The Task
Force advises against the practice of mouth-to-penis contact during
circumcision, which is part of some religious practices, because it
poses serious infectious risk to the child." While working at the New
York City Health Department, Task Force Chair Susan Blank, M.D. has
not banned metzitzah b'peh among fellow Jews who are Orthodox, and under
her watch babies have died of herpes as a result. There is so much
wrong with this new statement that it should immediately be rescinded.
The 1999 circumcision statement certainly had its flaws by ignoring
ethics and the anatomy and functions of the foreskin, but it wasn't as
atrocious as this new statement is.

American parents should take advice from foreign medical associations
that recognize that circumcision is medically unnecessary and has
serious ethical problems underlying the practice. Until the AAP uses
better judgment and rescinds this statement, parents should not look
to the AAP for advice on circumcision.

German Jews, Muslims unite to protest against circumcision ban

Berlin, Germany - Hundreds of German Jews and Muslims held a joint rally in Berlin on Sunday demanding that their "freedom of religion" be respected, in a rare show of unity to protest against a court order that banned ritual circumcisions.

The June ruling by a court in Cologne has sparked an emotive debate about religious freedom in a country which is sensitive to any accusations of intolerance because of its Nazi past.

Although the ban applied only to the Cologne region, doctors across the country have refused to carry out operations because of what they say is a risk of legal action.

Some 300 Muslim and Jewish protestors and their supporters gathered together at Berlin's Bebelplatz square, known as the site of the infamous Nazi book burning ceremony.

They waved banners reading "Foreskin? No Thank you", or "Finally, Germany is a colonial power again" against a cartoon image of a boy whose foreskin was the colors of the German flag. Some came wrapped in the Israeli flag.

"We were getting sick and tired of all the heated and incompetent gibberish on circumcisions," Lala Suesskind, the former head of Berlin's Jewish community, told Reuters.

"So today, we want to clarify a few things through our rabbi ... what circumcision really is and what circumcision means to our religion," she added.

...

Berlin last week became the first of Germany's 16 states to protect the practice, saying that doctors could legally circumcise infant boys for religious reasons.

Parents 'arranged female genital mutilation'

By Luke Eliot

The parents of a one-year-old girl have been charged after they allegedly took their child to Bali for a female genital mutilation procedure – believed to be the first case in WA.

Child abuse squad detectives charged the parents – a 44-year-old man and a 42-year-old woman – under Section 306 of the Criminal Code, which makes all procedures involving part or total removal of female genitalia or injuries to the female genital region for cultural or non-therapeutic reasons an offence.

It will be alleged the procedure took place during a holiday in Bali on August 25.

It is understood the couple live in Perth’s northern suburbs and the girl is understood to be in good health.

The Department for Child Protection website warns that being a parent or guardian consenting to the practice is not regarded as a defence and, if convicted, the maximum penalty for the offence is 10 years jail. The penalty for the offence if committed in WA is 20 years.

The World Health Organisation website says about 140 million girls and women are living with the consequences of female genital mutilation, which offers no health benefits.

WHO regards the practice as a violation of human rights which is motivated by beliefs about “proper sexual behaviour” including premarital virginity and marital fidelity.

It is also associate with cultural ideals of femininity and modesty including the notion girls are “clean” after the removal of body parts considered “male” or “unclean”.

The northern suburbs couple have been summonsed to appear in the Joondalup Magistrate’s Court on October 4.

The city-state of Berlin had announced a day earlier that it would not prosecute doctors conducting the ritual on boys in accordance with ancient Jewish and Muslim practice. But it said a mohel, a professional Jewish circumciser, could not claim the privilege.

The assembly of the city Jewish community passed a unanimous resolution saying, “this is flagrant interference in a Jewish tradition going back more than 3,000 years.”

A mohel is trained in the circumcision of baby boys and must live strictly according to kosher rules. Jewish groups said it would be rare to find a man who is both a mohel and a doctor at the same time.

The city-state said immunity from prosecution would apply on its territory if doctors used painkillers and obtained written parental consent and proof that the family belonged to a Jewish or Muslim community. Two other states said they had set similar conditions.

...

Jews are also concerned that Germany will demand use of a local anaesthetic during circumcision. One of Israel’s two chief rabbis has visited Berlin to say that this is not allowed in traditional circumcision.

Germany’s President Joachim Gauck released Thursday a letter to his Israeli counterpart, Shimon Peres, assuring him “the way of life and beliefs of Jews in Germany” needed to be protected. Peres had earlier asked Gauck to intervene and speak up for Jews.

Jewish groups plan a demonstration on Sunday in Berlin with Christian supporters to protest against the restrictions on circumcision. They have appealed to Muslims to also take part.

Muslims in Germany mostly ask doctors to perform circumcisions and have no equivalent of the mohel.

CAIRO: Gynecologists representing members of The Egyptian Society of Gynecology and Obstetrics, Professors of Gynecology and Obstetrics in Egyptian Universities, Ministry of Health and Population Hospitals, Teaching Hospitals, Military and Police Hospitals issued a declaration in the wake of recent convocation to perform Female Genital Mutilation (FGM) and refused calls to repeal the law prohibiting and criminalizing practitioners who perform it, the United Nations said in a statement.

As a result, the UN office in Cairo is holding a press conference on September 10 to address these recent events.

It is the latest battle between those who have called for an end to FGM in the country and those who continue to push for its legality.

...

Rights surveys in the country put the number of women who go through FGM to be around 86 percent. Current Egyptian law bans the practice and gives prison sentences to any medical staff who performs the surgery. However, many families go to underground clinics to get their daughters the procedure, risking permanent scares or even death.

Jacob's circumcision

By Frederike Haupt

A video shows how a tiny boy is circumcised. In another film can be seen as a little girl pierced ears are shot. Both videos showed the doctor Latasch at a meeting of the Ethics Board. The reactions were unexpected.

Jacob was eight days old, when his parents put him in white clothes and took him to the synagogue. Other adults were filming his circumcision. Now they all can see on Youtube: "The Circumcision of Jacob Chai". The video was to show the German Ethics Council how harmless circumcisions of young boys are. Fifty seconds in the life of Jacob. Leo Latasch, an experienced anesthetist from Frankfurt and a member of the Board of the Central Council of Jews in Germany had brought the video on his computer. As a member of the Ethics Board at its late August meeting , he announced in the first discussion of circumcision that he would explain both medical and religious issues from a Jewish perspective.

After three minutes, the professor said he would explain to the audience how a Jewish circumcision works, "because I assume that 99.5 percent of those who are here have never seen a circumcision." ... Then started Latasch the edited video of Jacob's circumcision, which he had stored on his computer.

... "For those who have not watched. The surgery lasted about twelve seconds," The video ends with Jacob's screams.

But the members of the ethics committee and the audience of about seventy in the public meeting saw and heard more. Leo Latasch played a second video, a few seconds after Jacob's, of a little girl having her ears pierced. ... Latasch had chosen the film to show that also is something painful and still allowed.

But a woman in the hall fell in a faint.... Another visitor was so sick that he had to leave the meeting room. A listener called "Sadist!" at Latasch. ... Latasch looked to Christiane Woopen, the chairman of the Ethics Board: What happened? Woopen shrugged. ...

But then he decided to keep going, as he said later. "What you have just seen is placing a earring", lectured Latasch. "When we talk about trauma, I think that you should look at this too." A spectator shouted "Cannibalistic!" then the session went on. Latasch spoke almost twenty minutes; he talked of the undiminished "performance" of circumcised men and the [Jewish community's] inability to give up the circumcision of newborns.

...

Jacob's circumcision may still be seen on the Internet. The video Latasch showed lasts fifty seconds, but in the original eight minutes and eight seconds.

...

NSFW:

Foreskin torn from the glans at 3:09, sliced off at 3:24, metzitzah b'pen at 3:40.

[Maybe earpiercing is a better comparison with circumcision than we thought, and both should wait for informed consent.]

Circumcision declared legal[allowable] in first of 16 German states

Ruling in Berlin city-state follows recent controversy that erupted when a Cologne court indicted a doctor with inflicting unlawful bodily harm by circumcising a 4-year-old boy.

Infant male circumcision was declared legal Wednesday in one of Germany's 16 states, following weeks of controversy about whether the Jewish and Muslim ritual is a crime or not. [What follows falls short of declaring it legal. It's more like turning a blind eye to it.]

The city-state of Berlin became the first to rule on the issue, saying its prosecutors had been instructed not to charge doctors if the boy's parents had consented in writing and proved they were religiously motivated.

...

While Berlin has moved more swiftly than the federal government or the other states to restore the procedure's legality, it has also imposed restrictions on it, including the duty to inform parents about any medical risks.

"If these criteria are fulfilled, circumcision will remain immune from prosecution," the state justice minister, Thomas Heilmann, said. "If medical standards are observed, circumcision at home or in a synagogue is also acceptable."

He said those standards included using all possible means of reducing pain and limiting bleeding. However, only doctors would be legally allowed to perform the procedure.

Heilmann said the state government did not have the power to authorize a mohel, or Jewish person trained in circumcision, to carry out the ritual. He said only the upcoming federal legislation could change that aspect of the law.

Chief Rabbi Metzger Tries to Set the Record Straight

At a shabbos event in Kerem B’Yavne, Ashkenazi Chief Rabbi Yonah Metzger Shlita explained that his efforts in Germany surrounding the bris milah controversy simply focused on educating officials to the differences between Jewish bris milah and Islamic circumcision.

Despite the chief rabbi’s good intentions, the echo heard from Germany is that his efforts appear to have complicated matters for the local Jewish community.

The chief rabbi told his hosts in Kerem B’Yavne that he explained the customs surrounding our bris milah on an infant as compared to the Islamic version, performed on a male without anesthesia, viewed as a cruel act while this is not the case with bris milah on an infant.

Whatever the case, for the leaders of the Jewish community in Germany, Rabbi Metzger’s efforts did not lead to a solution and for now, based on the Cologne court’s ruling, bris milah is illegal in that district of the country.

“For health care professionals who are going to be responsible for educating patients, [the updated report] provides them with a lot of rich information with which to do that,” said Andrew L. Freedman, MD, a member of the AAP’s task force on circumcision who helped write the guidance. [Here is an annotated version of the policy.]

However, the current guidance stops short of suggesting routine circumcision for all infant boys, partly because evidence of its health benefits is not strong enough to warrant it being a medical necessity, Dr. Freedman said. AAP changed its position, though, because of growing evidence that infant male circumcision could have positive health effects.

Let parents decide
The AAP encourages physicians to ensure that families understand that infant male circumcision is an elective procedure. The updated statement also accounts for the fact that male circumcision is not purely a medical decision, but includes aesthetic, cultural and religious factors as well, Dr. Freedman said.

“We recognize our ethical obligation is in the best interest of the child, and we don’t have the ability to judge the best interest of the child across all those paradigms,” said Dr. Freedman, a pediatric urologist at Cedars-Sinai Medical Center in Los Angeles. “If [families] want the procedure, they can justify getting it. If they don’t want it, they don’t have to have it.”

55% of males born in the U.S. each year are circumcised, compared with only 10% in Europe. [Actually much less - virtually no non-religious infant circumcision happens in Europe.]

The American Medical Association says the decision for neonatal circumcision should be determined by parents in circumstances in which the procedure is not essential to the child’s well-being.

The AAP was spurred to re-examine the issue in 2007 as mounting evidence linked higher prevalence of male circumcision to lower rates of herpes simplex virus type 2, HIV, human papillomavirus, penile cancer and urinary tract infections. [Yet the policy finds evidence for protection of each of those is slim.] The organization formed an eight-person multidisciplinary task force to examine the recent evidence on male circumcision.

...

Some disagreements
However, some opponents of circumcision question the accuracy and validity of the data on which the AAP based its updated statement and report.

Intact America, a New York nonprofit against infant circumcision, is demanding that the AAP retract its report “on the basis that it is inaccurate, biased and misleading,” among other charges.

Dr. Freedman said such backlash was expected. He said the AAP task force went out of its way in the technical report “to be inclusive, comprehensive and transparent as to the quality of the evidence.”

“As a practicing pediatric urologist, 20% of the patients I will see today are here because of something related to their circumcision,” Dr. Freedman said. “The procedure has some modest benefits and some modest risks.”

Families shouldn’t “feel like they’re harming their child no matter what they decide to do.”

[That figure is conservative compared to this]

Pediatric urologists spend as much as a quarter of their time correcting poorly performed circumcisions, says Dr. Clare Close, director of pediatric urology at the University of Chicago Hospitals. Close says parents often mistakenly think circumcision is a routine procedure anyone can perform.

Two children are dead, more are injured — yet a group of ultra-Orthodox rabbis say they plan to defy a health order in the name of religious freedom.

Less than a year after a Brooklyn tot died following an ancient circumcision ritual, the rabbis say they will ignore a proposed law that would mandate parental-consent forms before performing the dangerous procedure.

Over the past decade, at least one other newborn died after contracting herpes from the rite, in which the rabbi draws blood from the penis with his mouth.

But ultra-Orthodox leaders are lashing out at the city’s “evil plans” ahead of the Board of Health’s vote next week.

About 200 rabbis signed a proclamation claiming the Health Department “printed and spread lies . . . in order to justify their evil decree.”

“It is clear to us, that there is not even an iota of blame or danger in this ancient and holy custom,” the letter states.

E-letters to Pediatrics all critical of AAP policy

Three letters were published in Pediatrics, the journal of the American Academy of Pediatrics, before the weekend. All were critical of its circumcision policy. (Another part of the Pediatrics website is also publishing responses to the policy. Yet another is here.)

Among many basic errors of epidemiology, the authors do not even understand how to calculate Number Needed to Treat. (From p. e767: "Given that the risk of UTI among this population is approximately 1%, the number needed to circumcise to prevent UTI is approximately 100.")

Two of the referenced papers from which this figure was derived, written by investigators who do understand how to calculate NNT, found respectively that 111 and 195 circumcisions were needed to prevent one UTI. These data were reported in the abstracts.

Finally, for the authors to say "Most available data were published before 1995 and consistently show an association between the lack of circumcision and increased risk of UTI" and then arbitrarily exclude all data prior to 1995 is an unforgiveable design flaw.

This paper is epidemiologically incompetent and an embarrassment to the AAP.

EHR SIIS & Informed Consent Document Needed

Eileen M. Wayne, Director
InformedConsent.org, Inc. 501 C3

I am an informed consent expert witness. I represent the patient, not the patient's parents, surgeon, pediatrician, or religious representative.

Surgery in general, & amputative surgery in particular, must follow the rule of "Severity of Illness, Intensity of Service." Starting with local therapy, progressing to oral, then intravenous therapy, all must be documented to have failed before contemplating amputative surgery. ...

... strong objections to its principle findings and recommendations must be made.

It is not true that Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it.

The unresolved injuries and risks of inflicted pain have yet to be resolved ... . The analytic legal and judicial issues of inflicting pain upon an unconsenting person were not addressed ...

The forceable shredding of the foreskin from the glans--a fused biological organ in newborns and young children--is an act of torture, as is the stripping of the skin from the body is universally recognized as an act of torture that is prohibited by the Universal Declaration of Human Rights and the U.N. Convention on the Rights of the Child. a) No child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment

...

Judith Palfrey, M.D., Past President, American Academy of Pediatrics was compelled to renounce the AAP Bioethics Committee's policy statement on Ritual Cutting of Female Minors with the following statement: "The AAP does not endorse the practice of offering a "clitoral nick". This minimal pinprick is forbidden under federal law..." (17 May 2010).

...

The equal protection clause of the 14th Amendment to the US, Constitution extends the protection of PL 104-208 to male children ...

To affirm that FGM and not MGM is an act of torture defies reality and judicial rulings.

The American Academy of Pediatrics has misused its authority by not addressing the analytic legal, judicial, cultural and religious history of genital mutilation that has so influenced medical opinion and practices throughout human history and has corrupted its current and wrongful recommendations on circumcision.

There are no religious rights or freedoms to inflict harm or injury upon another person contrary to the history of religious traditions and medical history.

There are no parental or medical rights to the sexual abuse of newborns/children, which genital mutilation entails. FIRST, DO NO HARM

A clash of cultural practices and the enjoyment of civil liberties

By Henry Wasilwa

Among the Bukusu, in western Kenya, a young male child is obliged by customary practice, to undergo the traditional circumcision. It is taboo to cringe, flee or show open fear of the cut and that the entire family is ostracised if the initiate fails to withstand the cut as expected.

A recent occurrence that was featured in The Standard On Saturday, brings to the fore the choice between complying with this painful cultural practices and the enjoyment of civil liberties such as freedom from forceful or harmful practices.

Article 25 of the Constitution ensures that certain human rights can never be modified, limited or affected by anything not even custom or tradition, and it protects every person’s freedom from torture and cruelty, and proscribes inhuman or degrading treatment or punishment; In the hierarchy of laws, custom or traditional practices rank way below constitutional edicts, statutory imperatives, subsidiary legislation, and the common law. Any custom that abridges, diminishes, or in any way impinges on the right to life and limb, is at once repugnant to the Constitution for violating the higher element of the human rights set out in Article 25 of the Constitution.

Initiation in the manner prescribed by Bukusu custom might have been designed to compel the subject to undergo a process of pain, and perseverance, ostensibly to celebrate the symbolic transition from adolescence into adulthood. The manner prescribed for managing the resultant wound was by application of the leaves from a traditional herb known as “enguu” or in some Luhya dialects, “ingwe” thought to be an antiseptic; and any swelling on the organ is to be relieved by puncturing the swollen membrane with the means of some thorny flower called “namusuni” named after the tiny red breasted bird that suckles the flower’s nectar.

Others would use the horrifying mandibles of a live ant known for its vicious bite to puncture any septic part of the organ and in the process release any septic fluid. This would impart the most excruciating pain imaginable to the septic part of the initiate and in Bukusu custom, such pain depicted bravery and brawn in the initiate anything else is considered woolly.

I asked an elder why this practice and he said it prepared an initiate on how to consciously process and accept, deprivation, deal with inconvenience, extreme conditions of weather, and how to emerge from the horror of direct pain to the body. Perhaps these were useful attributes for men in the days of hunters and gatherers because the process of securing food and subsistence was fraught with danger, pain, deprivation and inconvenience.

Any utilitative purpose that such practice might have served, can no longer be justified in a market economy in which the dangerous hunting moors have now been replaced by supermarkets, the stock exchange and other platforms of accessing basic human livelihood and succour.

Any benefits that circumcision delivers can be obtained by humane, clinically efficient and hygienic means in a hospital, without taking away the core benefit, if any. With so many practical reasons falling away, it is now difficult to defend this system of removal of the foreskin.

The young hapless lad of the Baala clan, recently featured, wailing and screaming in horror during his forceful cut, should consider bringing a petition in any court that his constitutional right to his civil liberties, were flagrantly infringed by his Bukusu customary circumcision. Indeed this young boy could, in theory file a similar petition to obtain compensation for assault, humiliation and the deliberate denigration of his civil rights by his father, clan and the local administration. I believe civil rights groups like the Cradle would snap up and support, such a case.

In the mid seventies when I underwent the traditional cut, I did it voluntarily but had I flunked the test, together with my family, I would have been considered pariah forever.

US doctors' stand on circumcision changes again

By Michael Cook

For the fourth time in 40 years the American Academy of Pediatricians has changed its tune on the controversial topic of infant circumcision. It now says that “preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure”. These benefits include: “significant reductions in the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquisition of HIV and the transmission of other sexually transmitted infections”.

The AAP has worded its new policy carefully. The benefits do not appear to be significant enough to justify recommending routine circumcision, but enough to justify it for parents who insist on it. This neat compromise will allow Jewish and Muslim families to circumcise their sons without acrimonious disputes.

On the ethics of circumcision, the AAP has little to say. Its brief statement did not address the problem of non-consent from the infant. In the US the popularity of the procedure has been in decline, but half of newborn boys are still circumcised. Opponents, known as “intactivists”, claim that it is a potentially dangerous cosmetic procedure which amounts to genital mutilation.

Neither side seems to have an open-and-shut case. Elizabeth Reis, of the University of Oregon, points out in the Bioethics Forum of The Hastings Center that the AAP has changed its mind on the issue several times. In 1971 the AAP decided that it was not a medical necessity; in 1989 that it might be helpful; in 1999 that it probably wasn’t; and now that it probably is.

Michigan group to protest report urging circumcision

The Michigan March for Integrity plans to gather at noon to blast an American Academy of Pediatrics report this week that favors the age-old practice.

The doctors group found benefits to the surgery "outweigh the risks." Protesters disagree.

"Circumcision is the only surgery performed on children without a diagnosis," said Norm Cohen, state director of NOCIRC of Michigan, who expects about 40 people at the protest. "It violates their inalienable right to bodily integrity.The genital cutting of children is an ancient obsession in need of a rational basis."

Dr. Brian Berman, the chairman of pediatrics at Beaumont Children's Hospital, said the hospital leaves the decision to parents and supports the policy statement from the American Academy of Pediatrics.

"We encourage families to thoughtfully discuss options with their care providers," he said, adding the policy "found the health benefits of circumcision outweigh the risks, but are not great enough to recommend universal circumcision."

Cohen said Michigan ranks as the No. 1 state in the country for circumcision, with 87 percent of newborn boys undergoing the procedure annually. The rate of hospital circumcision has dropped nationwide from about 80 percent in the 1980s to 55 percent now.